Abraham Rest Home

Type of visit: Required - 1 Year

On 02/23/2023 at 12:15 PM, Licensing Program Analyst (LPA) J. Sampair conducted an infection control annual inspection. LPA explained the purpose of the visit with Administrator (ADM) Annette Sanchez. LPA inspected the facility inside and outside. Facility has an infection control plan in place that they are following. The designated infection control leader is the administrator. Adequate supplies of PPE were stored on the premises. A written Emergency/Disaster plan was posted on the bulletin board for staff, clients and visitors to read. There were at least 7 days of nonperishable and 2 days of perishable foods. Centrally stored medications were stored in locked cabinets. LPA observed fire extinguisher was fully charged and serviced within the past 12 months. Smoke and Carbon monoxide detectors were operational. Toxic chemicals were stored in a locked closet. Facility cited with 1 Type A and 2 Type B deficiencies. ADM will send updated copies of the following to CCL on or before 03/02/2023: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610E- Emergency/Disaster Plan · Evidence of Liability Insurance Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, Feb 23, 2023

Type of visit: Required - 1 Year

On 05/03/2022 at 11:30AM, Licensing Program Analyst (LPA) J. Sampair conducted an infection control annual inspection. LPA explained the purpose of the visit with S1 upon entry, who then called the administrator who arrived at 12:15PM. Facility has a mitigation plan (LIC 808) in place dated 02/22/2021 to mitigate the spread of COVID-19. LPA discussed the importance of having an updated infection control plan in accordance with PIN 22-13-ASC. LPA inspected the facility inside and outside. LPA observed the 2 staff assisting 6 of the 6 clients with activities of daily living. One central entry point has been designated for universal entry screening with the station located near the front entrance with visitor's log, hand sanitizer, face masks, and no touch temperature probe. COVID-19 signs were posted throughout the facility to promote hand washing, cough/sneeze etiquette and physical distancing. A written Emergency/Disaster plan was posted on the bulletin board for staff, clients and visitors to read. There were at least 7 days of nonperishable and 2 days of perishable foods. Centrally stored medications were locked in the cabinets. Sharp objects were locked underneath the kitchen sink. Toxic chemicals were stored in a locked closet inside the laundry room. Infection control designated leader is the administrator. Continued on next page LIC 809-C Administrator is on site a minimum of 20 hours a week to oversee proper business operation. LPA observed fire extinguisher was fully charged. All staff and 6 clients have been fully vaccinated. Smoke and Carbon monoxide detectors were operational. Adequate supplies of PPE were also observed stored on the premises. Facility follows daily cleaning, sanitation of frequently touched common surfaces with disinfectants. Updated copies of the following documents were requested for facility file and are to be submitted to CCL on or before 05/10/2022: · LIC500- Personnel Report · LIC308- Designation of Facility Responsibility · LIC610D- Emergency/Disaster Plan · Evidence of Liability Insurance & Surety Bond Facility cited with 1 Type A and 1 Type B deficiencies. Exit interview conducted and a copy of this report provided via email.the state’s words, verbatim · CDSS document, May 3, 2022

Allegation investigated: Resident (R1) has taken other resident's medications,

Licensing Program Analysts (LPAs) Alicia Delmundo and Catherine LIn arrived unannounced to conduct investigation of the above allegation. LPAs met with staff, Linda Kengne and Sarah Nakiwala. LPA called and spoke with Annettte Sanchez, licensee-administrator, and informed the purpose of LPAs' visit. Annette arrived after about fourty minutes. LPAs also met with Sarah Abraham, assistant manager. LPAs reviewed residents' file, and conducted interviews and inspection. LPA obtained copies of the following resident's documents: LIC602A Physician's Report; doctor's order of medications; Medication Administration Records; LIC622 Centrally Stored Medication and Destruction Record. LPA Delmundo reviewed the incident report submitted by Annette Sanchez to Community Care Licensing dated July 29, 2021. ....continued on 9099C Substantiated Review of R1's Physician's Report revealed R1 needs assistance on administration of medications. During interview, Annette Sanchez indicated she was at the facility when the incident happened when R1 has taken the medications for R2. Staff S1 was to administer medications to R2 when R1 called for help. S1 brought R2's medications and placed on top of a cup board in R1's room, and R1 took R2's medications. These collaborated with S1's statement. Based on the information obtained that staff brought R2's in R1's room when R1 called for help and R1 took R2's medications, the allegation is substantiated. A finding that the complaint is substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. Deficiency is cited from Title 22 California Code of Regulations (see 9099D). Failure to submit proof of correction (POC) by plan of correction due date and any repeat violations within 12 month period may result in civil penalties. Deficiency and plan and proof of correction were discussed with Annette Sanchez and Sarah Abraham. Exit interview conducted. Appeal Rights, LIC9098 Proof of Correction form and copy of this report provided to Sarah Abraham.the state’s words, verbatim · CDSS document, Aug 11, 2021 · control 15-AS-20210802105757

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(5) · Plan of correction due date: Aug 12, 2021

87465 Incidental Medical and Dental Care: (a)........ (5) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by: -Based on review of records and interview, the licensee did not comply with the section cited above. Staff brought R2's medications in R1's room which R1 has taken. This posed immediate health risk to person in care,the state’s words, verbatim · CDSS document, Aug 11, 2021

Plan of correction: Licensee to in-service the staff and submit proof by 8/12/2021.